School underachievement related to perinatal morbidity in preterm children with various birth weights

2.50
Hdl Handle:
http://hdl.handle.net/10755/163674
Category:
Abstract
Type:
Presentation
Title:
School underachievement related to perinatal morbidity in preterm children with various birth weights
Author(s):
McGrath, Margaret; Sullivan, Mary C.
Author Details:
Margaret McGrath, Professor, University of Rhode Island, College of Nursing, Warwick, Rhode Island, USA, email: risc@etal.uri.edu; Mary C. Sullivan
Abstract:
Purpose: Medical technology and neonatal intensive care unit (NICU) are responsible for dramatic decreases in mortality for low birth weight infants. However, morbidity in these children is estimated to be 30% to 60% due to neurodevelopmental, motoric, and cognitive impairment. School-age findings for these children are equivocal. Differential effects of perinatal morbidity have been recognized as important in generating more accurate estimates of risk. However, many outcome studies fail to admit the heterogeneity of prematurity and, therefore, not all are at equal risk for school underachievement. The purpose of this study is to identify specific perinatal morbidity events secondary to disruptions in oxygen regulation and metabolic processes and relate them to later school outcomes. Specific Aim(s): This prospective longitudinal study evaluated school outcomes at age 8 in term and preterm children grouped by birth weight. Cognitive, motor, and academic outcomes were investigated for children who experienced intraventricular hemorrhage, chronic lung disease, seizures, pneumonia, meningitis, necrotizing enterocolitis, and septicemia . Framework: This study utilizes a risk and protection framework specifically defining risk as medical, neurological, and low birth weight. This model assumes that school age outcomes are influenced by risk, as well as, protective factors in the family and environment. Methods: One hundred, eight-nine children: 151 preterm infants from the NICU and one group of full-term (n=38) were recruited from the newborn nursery. Three preterm groups were a low birth weight group (LBW; > 1500g< 25OOg [n=51]); a very low birth weight group (VLBW; > 1000g< 15OOg [n=52]); and an extremely low birth weight group (ELBW; < 1OOOG [n=48]). The groups included children with a range of mild to severe medical complications. At age 8, 97% of the sample participated in a comprehensive developmental battery including cognitive, academic achievement and productivity, attention, visual-perceptual skills, and fine and gross motor assessment. Results and Conclusions: Hypoxic-ischemia and metabolic disorders in the perinatal period had specific deficits affecting school underachievement. In school performance, reading, math, and visual perception, the differences between birth weight groups averaged IO points. Children with Grades III and IV IVH had scores 15 points (1 SD) lower in cognition and math achievement. Children with chronic lung disease had scores I SD below the mean in cognition, math, spelling, and visual-performance. Sepsis specifically affected visualperception, motor, and reading skills at age 8 with a 1 SD decrease in scores. Sixteen and 17% of LBW and VLBW children respectively were diagnosed with ADHD, double the national average. There was a three-to-four-fold increase in psychological evaluation, speech and language delays, special education and resource services in the LBW, VLBW, and ELBW groups compared to the full-term group. All of these differences are both statistically and clinically significant. Implications: This study adds to the body of knowledge of NICU survivors. The biological insult in concert with complexities of medical morbidity and low birth weight place some children born preterm at increased risk for specific developmental outcomes. The knowledge can serve as a basis for professional practice to enhance health care for families of high-risk children.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleSchool underachievement related to perinatal morbidity in preterm children with various birth weightsen_GB
dc.contributor.authorMcGrath, Margareten_US
dc.contributor.authorSullivan, Mary C.en_US
dc.author.detailsMargaret McGrath, Professor, University of Rhode Island, College of Nursing, Warwick, Rhode Island, USA, email: risc@etal.uri.edu; Mary C. Sullivanen_US
dc.identifier.urihttp://hdl.handle.net/10755/163674-
dc.description.abstractPurpose: Medical technology and neonatal intensive care unit (NICU) are responsible for dramatic decreases in mortality for low birth weight infants. However, morbidity in these children is estimated to be 30% to 60% due to neurodevelopmental, motoric, and cognitive impairment. School-age findings for these children are equivocal. Differential effects of perinatal morbidity have been recognized as important in generating more accurate estimates of risk. However, many outcome studies fail to admit the heterogeneity of prematurity and, therefore, not all are at equal risk for school underachievement. The purpose of this study is to identify specific perinatal morbidity events secondary to disruptions in oxygen regulation and metabolic processes and relate them to later school outcomes. Specific Aim(s): This prospective longitudinal study evaluated school outcomes at age 8 in term and preterm children grouped by birth weight. Cognitive, motor, and academic outcomes were investigated for children who experienced intraventricular hemorrhage, chronic lung disease, seizures, pneumonia, meningitis, necrotizing enterocolitis, and septicemia . Framework: This study utilizes a risk and protection framework specifically defining risk as medical, neurological, and low birth weight. This model assumes that school age outcomes are influenced by risk, as well as, protective factors in the family and environment. Methods: One hundred, eight-nine children: 151 preterm infants from the NICU and one group of full-term (n=38) were recruited from the newborn nursery. Three preterm groups were a low birth weight group (LBW; > 1500g< 25OOg [n=51]); a very low birth weight group (VLBW; > 1000g< 15OOg [n=52]); and an extremely low birth weight group (ELBW; < 1OOOG [n=48]). The groups included children with a range of mild to severe medical complications. At age 8, 97% of the sample participated in a comprehensive developmental battery including cognitive, academic achievement and productivity, attention, visual-perceptual skills, and fine and gross motor assessment. Results and Conclusions: Hypoxic-ischemia and metabolic disorders in the perinatal period had specific deficits affecting school underachievement. In school performance, reading, math, and visual perception, the differences between birth weight groups averaged IO points. Children with Grades III and IV IVH had scores 15 points (1 SD) lower in cognition and math achievement. Children with chronic lung disease had scores I SD below the mean in cognition, math, spelling, and visual-performance. Sepsis specifically affected visualperception, motor, and reading skills at age 8 with a 1 SD decrease in scores. Sixteen and 17% of LBW and VLBW children respectively were diagnosed with ADHD, double the national average. There was a three-to-four-fold increase in psychological evaluation, speech and language delays, special education and resource services in the LBW, VLBW, and ELBW groups compared to the full-term group. All of these differences are both statistically and clinically significant. Implications: This study adds to the body of knowledge of NICU survivors. The biological insult in concert with complexities of medical morbidity and low birth weight place some children born preterm at increased risk for specific developmental outcomes. The knowledge can serve as a basis for professional practice to enhance health care for families of high-risk children.en_GB
dc.date.available2011-10-27T11:11:47Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:11:47Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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